PROMISES AND PITFALLS : MEDICAL CANNABIS AND PUBLIC HEALTH

One of the key challenges facing regulators and producers in implementing medical cannabis programmes in any jurisdiction is how to do so in a way that best promotes and protects public health.

Medical cannabis programmes come with their own unique set of public health issues to consider, more so, perhaps, than regulated recreational cannabis models. Potential pitfalls are abundant. There is, for example, the decades-old debate over whether medical cannabis should be available in a smokable form (as it is in many US States including California and Colorado) or whether it might be better to require patients to vaporise, eat, or otherwise consume their medicine in a more pharmaceutically conventional form that does not involve the combustion of plant matter.

Extract-only regulatory models allow more accurate dosing and avoid any potential negative health impacts from smoking – including the temptation to consume cannabis alongside tobacco – a key public health concern. This is the model advocated by Michael Abbott, co-founder of Columbia Care, who will be speaking at Cannabis Europa. Others argue, however, that doing so would unnecessarily restrict patients’ access to a useful medical product and options for consumption, with little or no benefit to public health.

Other potential problems abound. Should medical cannabis patients, for example, be allowed to grow their own plants? And, if so, then what restrictions should be placed on them, if any? Jurisdictions that allow personal cultivation for patients provide a valuable route of access, but they may open themselves up to abuse of the system if not well regulated.

On the other hand, if medical cannabis programmes can indeed reduce the number of opioid prescriptions, or help people to overcome addictions to other drugs (as many have claimed), do these benefits outweigh any harms? Medical cannabis has been proposed as an efficacious, inexpensive alternative to a plethora of prescription medicines, but the relationship between medical cannabis access programmes and prescription rates is more complicated than it first seems.

Medical cannabis programmes – where they are introduced without a corresponding recreational programme – must also confront the issue of how to effectively ensure that medical cannabis products do not end up on the recreational black market. On that front, as on many others, there are plenty of lessons to be learned from existing medical frameworks.

It is these thorny issues that the public health panel will be tackling at Cannabis Europa. Join us to hear Harry Sumnall Professor of Substance Use at the Public Health Institute Liverpool John Moors University, Chandni Hindocha PhD researcher at the Clinical Psychopharmacology Unit, University College London, Brendan Hughes, Principle Legal Analyst at the EMCDDA and Dr Henry Fisher, Partner at Hanway Associates, weigh up the potential challenges to public health against the possible benefits.

A balancing act must be negotiated between being too strict, and running the risk of patients not being able to access their medicine at all, and being overly lax, thereby blurring the line between medical and non-medical use. All of the speakers at Cannabis Europa will have had to perform or examine this balancing act in some form or another in their work, and all will be acutely aware of the risks and rewards.